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  • ATFL Tear - Ultra Marathon Runner

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    Old 03-30-2018, 10:12 PM   #1
    Amit's Avatar
    Join Date: Mar 2018
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    Amit HB User
    ATFL Tear - Ultra Marathon Runner

    Hi Everyone

    I am a long distance runner.

    In June last year I experienced some pain during a training run. Then some swelling on the right ankle. Took a few weeks off and things were OK. Then again in September 2017, the pain started increasing in severity & frequency. Some days were really bad to where I couldn't sleep - so went in for an MRI which showed fluid secretion in the ankle joint & mild ankle effusion.

    I had to take some weeks off, did some physio work, and got back to some running in December - but things turned bad quickly and December 2nd week I went in for an ultra-sound - they found a large ganglion, so they cut that up and injected some steroid. Asked me to rest for 10 days and resume. Did just that, but it didn't improve so got a 2nd MRI.

    The 2nd MRI showed two findings:
    1. Peroneus brevis longitudinal split
    2. Anterior lower fibular mild osseous remodeling with slender attenuated fibular attachment anterior talofibular ligament remnant. Remodeled fibular attachment calcaneofibular ligament.

    So I took all of January off - focused on physio - changed my shoes from zero-drop to max cushion and resumed running in Feburary. Things were OK for a few weeks but pain returned.

    Went in for an ultra-sound yesterday and they say there is a chronic tear of the ATFL. The CFL seems intact.


    Now, my question is ---- should I opt for ATFL reconstructive surgery - or can I get rid of the situation via just physio/rehab?

    1. I do not have chronic instability - i don't feel my ankle will give way or roll during running. Sure, it is not as stable as the left ankle, but I can stand on it with a single leg stand on ground as well as an unstable surface like a bosu ball.

    2. I have a lot of pain. Some days are good while some days are painful. Pain at rest, pain while walking. It's radiating and all over the ankle, top of the foot, and on the side of the ankle up the sock line

    I want to return to running as fast as possible. I'm OK taking 6 months off if I have to get surgery, or investing 6 months into rehab. I just want to make the right decision so that I don't lose time.

    I'm afraid that if I opt for 4-6 month of rehab and then resume running and then if things don't work then I opt for surgery and its another 6 months.

    And, with surgery, my physio says it isn't required and we can fight this without it.

    Any opinion would be great!

    Last edited by Administrator; 03-30-2018 at 11:05 PM.

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    Old 03-31-2018, 11:42 AM   #2
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    Join Date: Dec 2016
    Location: Colorado
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    FlatFootTeacher HB User
    Re: ATFL Tear - Ultra Marathon Runner

    First off, I am not a runner and have no clue what runners go through with training, running etc, so this is just my experience to share with you. I also have a tear in my peroneal brevis, but not the ligament. Iíve tried months of PT and a boot, and even tried a *** shot (3 weeks in a hard cast and 7 weeks in a boot) in February that hasnít worked either. I had my follow up from my *** this past week, and my doctor said since we have tried pretty much all the non surgical things we can, that it might be time for surgery. However, what was interesting was my doctor said it was up to me if I have the surgery at all. He told me it was totally up to me and my pain level. I have moderate pain some of the time, and some of the time I am fine and very minimal pain. Iím not sure it hurts bad enough to get the surgery yet. My doctor said that sure it might tear more if I donít get the surgery, but it also might not. It is sooo hard to decide what to do. What Iíve decided to do is wait until next year and see how things feel then. I am a teacher and can only really do my surgery during the summer, but this summer I am planning on having a significant eye surgery. What I worry about is my pain after the surgery. Things can happen and nerves can be worse after the surgery, and what if there are complications or infection or something like that? For me, the unknowns are too much of a gamble for my pain level right now. If it starts to hurt worst and it totally effects my daily life, then I might do the surgery sooner than later. For you, I think you just need to weigh pros and cons. PT works for many people, wearing a boot helps many people, and *** works for many people too. None worked for me, but what I feel good about is trying all the conservative approaches before surgery. I am always one to try conservatives first, but if you are wanting something fast, then Iíd go with the surgery. Going the conservative route takes a long time, and it may not even work. Surgery is almost always a sure thing, but you never know. No one can really tell you what to do. Good luck with your decision.

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